WOW February 2017

Page 6 Volume 17; Issue

Page 6 Volume 17; Issue 2 A Centralized Electronic Health Record: How Close Are We? Ben Iredell, PharmD, PGY1 Medication Systems and Operations Resident A patient is admitted with pneumonia on Friday evening, but she claims she has a history of anaphylaxis with multiple antibiotics. She does not recall which ones specifically, and her out of state Primary Care office will not be open until Monday. Skin testing aside, the patient may have to go the weekend without antibiotics. These situations unfortunately happen frequently due to a lack of universal integration among health systems’ Electronic Health Records (EHR). However, there are efforts underway to connect health systems across the country. In 2004, President George W. Bush set a goal that by 2014, most Americans should have access to secure electronic health records. 3 The executive order foresaw that medical information would follow consumers from provider to provider and that each clinician would have a patient’s complete medical record. Now, in 2017, we still have yet to reach that goal. A government initiative, endingthedocumentgame.gov, was implemented to reduce the number of duplicate documents and tests from provider to provider. 3 In 2009, Congress passed the Health Information Technology for Economic and Clinical Health Act (HITECH Act), which authorized the Department of Health and Human Services to spend $30 billion on the expansion of Heath Information Technology (HIT). 3 The act defines “meaningful use” in terms of HIT and improving clinical outcomes using EHR technology. 2 While progress at the national level lags, some states are having success with creating regional Health Information Exchanges (HIE). The California Integrated Data Exchange (Cal INDEX) is a nonprofit organization that is funded by two large health insurance companies in the state. The organization maintains a centralized EHR that is populated with patient health information by providers and by insurance claims. While not completely comprehensive, this is a good start to a one-stop health record. Other states have created or have plans for similar systems, including Georgia, Arkansas, and Virginia. In Maryland, the Chesapeake Regional Information System for our Patients (CRISP) organization is leading the way towards a centralized EHR in Maryland and the District of Columbia. 1 The CRISP Clinical Query Portal is a free tool available now to ambulatory practices, and the Prescription Drug Monitoring Program (PDMP), which allows for a common repository of data related to controlled substance prescribing and dispensing, is one of the more mature aspects of Maryland’s program. Besides clinical benefits such as enabling faster diagnoses and improving comprehensive care, a centralized EHR will save health systems money. For example, a complete patient record will show the provider all tests performed on the patient, which may eliminate duplicate or unnecessary tests. Additionally, providers and health systems will not spend as much time learning new systems or transferring health information if it is already synced across all health systems. While 2014 has come and gone and nation-wide connected patient records has yet to be achieved, progress is being made on the local and national levels. CRISP, while a relatively new system, has the potential to connect patient records for hospitals and health systems in Maryland and the District of Columbia. With time, the hope is that every health system in America will be connected and each patient’s antibiotic allergies (and other health-related information) will be available to all providers. References: 1. CRISP Clinical Query Portal. CRISP. https://www.crisphealth.org/ services/crisp-clinical-query-portal/. Accessed December 2016. 2. Health Information Technology. American College of Emergency Physicians. https://www.acep.org/Advocacy/Health-Information- Technology/. Accessed December 2016. 3. Kendall, D., Quill, E. A lifetime electronic health record for every american. Third Way: Fresh Thinking. http://www.thirdway.org/ report/a-lifetime-electronic-health-record-for-every-american. Accessed December 2016. 4. Koppel, R.. What do we know about medical errors associated with electronic medical records? The Health Care Blog. http:// thehealthcareblog.com/blog/2016/01/11/what-do-we-know-aboutmedical-errors-associated-with-electronic-medical-records/. cessed December 2016. Ac- Our “Epic” Summer Detron Brown, PharmD Candidate, Howard University College of Pharmacy, Class of 2018 Megan Bereda, PharmD Candidate, Purdue College of Pharmacy, Class of 2018 On July 1 st of 2016, the Johns Hopkins Hospital finalized its transition to Epic as its exclusive electronic health record. This was one of the largest changes in Hopkins’ history and meant extensive workflow and standard operating procedure changes. Many were left feeling uneasy of being able to utilize the system while still providing the highest level of care. As summer interns in the Critical Care and Surgery (CCS) Pharmacy, we were tasked with easing the stress of the transition. While undergoing the Epic-provided training alongside our technicians, we recognized that while the training was a great introduction to the software, we could further serve our technicians by providing hands-on use of the software. We recognized that if the training included more real-life experiences and scenarios, the technician level of comfort would increase significantly. Together we compiled a technician training program that focused on the six major functions that we felt were the most vital for technician success in the new Epic system. Eighty-six percent of the full-time CCS technicians were cotrained prior to “Go-Live” on July 1, 2016. Through our individual training sessions, we were able to teach each of the major func- (continued on page 7)

Page 7 Volume 17; Issue 2 Our “Epic” Summer (continued from page 6) tions and observe each technician’s competence with them. Upon completion of the mock scenarios prepared in the Epic Hyperspace training modules, we were able to directly serve as a resource and observe each technician’s “real-time” competence. Many technicians cited this training module as a significant factor in increasing their comfort in maneuvering through the new system. At ASHP’s Midyear Clinical Meeting in December, we presented our work and described the benefit of site specific one-onone training versus non-specific group training. We are forever grateful for experiences we were able to have over the summer and the support we received from the CCS pharmacy staff and summer internship program. The Johns Hopkins Hospital at Fundación Santa Fe de Bogotá Mustafa Sidik, CPhT The Department of Pharmacy had the opportunity to send a pharmacy technician to the Fundación Santa Fe de Bogotá, an international affiliate of Johns Hopkins, to present on pharmacy technician practice during a two day national pharmacy conference. The hospital had no formal pharmacy technician role, and was seeking to learn how to effectively implement a successful, sustainable pharmacy technician position. I was fortunate to be chosen as the Johns Hopkins representative and wanted to share my experience. I presented two lecture to approximately 300 pharmacy professionals from across Colombia: one on the role of the pharmacy technician in the United States and the other on the role of the pharmacy technician in medication safety. Following the lectures I discussed specific pharmacy technician roles with pharmacy and hospital executives. A tour of the hospital, including the central pharmacy and many of its satellites rounded out the first day. The second day was spent in targeted focus groups, where discussions were held with the hospital’s current pharmacists, associates, and administrators, as well as representatives from the country’s Board of Pharmacy and Health Ministry. After the two days, the consensus was reached that while it is critical for the role of the pharmacy technician to develop, it is equally as critical for the hospital’s program to be rooted firmly in education and training to adequately prepare individuals to be competent pharmacy technicians. Overall, this trip was an eye-opening experience to all that we take for granted in pharmacy practice, not only at The Johns Hopkins Hospital, but the United States as well. Technologies such as Pyxis, Epic, and DoseEdge which we rely on heavily, are not accessible in many other countries. This opportunity gave me a newfound appreciation for the level of progress that The Johns Hopkins Hospital Department of Pharmacy has achieved and the steps we are taking to advance pharmacy practice. Indispensable Impact Kristen Holt, PharmD, MPH, Pharmacy Administration Last year, clinical pharmacists made over 90,000 recommendations that benefited the care of patients at The Johns Hopkins Hospital. These interventions were incorporated by the care team 98% of the time. Using your imagination; how could this patient’s story have unfolded differently if this pharmacist was not there to intervene? A pregnant patient was ordered haloperidol short acting 100 mg intramuscularly (IM) once. The pharmacist paged the provider to inform her that haloperidol should be avoided in the first trimester of pregnancy since there is the potential for limb malformations. In addition, 100 mg IM once should be the long acting and not the short acting formulation. The drug was discontinued. Pharmacists at Johns Hopkins are dedicated to help patients benefit from their medications safely, effectively, and affordably. Each scenario illustrates a clinical pharmacist’s indispensable impact.